A New Paradigm: Prevention of Central Sensitization in Pain Management through Minimizing Opioid Exposure

This case focuses on pain hypersensitivity by asking the question: Are primary afferent-induced hypersensitivity states dependent on the activation of N-methyl-d-aspartate (NMDA) receptors, and is windup (perceived increase in pain intensity with a repeatedly delivered stimulus) a possible trigger for the production of central hypersensitivity? This study demonstrated that the induction and maintenance of central sensitization are dependent on NMDA receptor activation. NMDA receptor antagonists have been shown to prevent the manifestation of central sensitization as well as to decrease established hyperactivity in pain pathways. NMDA receptor antagonists play an important role in pain management.

Az ultrahang-képalkotás alkalmazása biotechnikai előrelépés a perioperatív fájdalomcsillapításban

Orvosi Hetilap ◽

10.1556/650.2019.31374 ◽

2019 ◽

Vol 160 (15) ◽

pp. 573-584

Author(s):

Róbert Gyula Almási

Keyword(s):

Nervous System ◽

Pain Management ◽

Side Effects ◽

Postoperative Pain ◽

Peripheral Nerve ◽

General Anaesthesia ◽

Central Sensitization ◽

Regional Anaesthesia ◽

Nerve Blockade ◽

Peripheral Nerve Blockade

Abstract: The perioperative pain management – instead of the efforts, guidelines and protocols – is underestimated and undertreated. Even in the case of general anaesthesia, the nervous system is overwhelmed by copious quantities of nociceptive stimuli at surgical incision. Stress and pain-modulation processes are triggered which can have significant influence on the outcome. Often the pain-management is discontinued, so a notable part of patients complain about pain in the ward after surgery. Regional anaesthesia conceptually prevents noxious inputs to enter the central nervous system, beyond surgical anaesthesia it is pertinent to achieve excellent analgesia in the immediate postoperative period as well. Based on current literature, this paper provides an overview of the history and role of regional anaesthesia in the multidimensional model of pain. Besides the sensitization caused by nociceptive stimuli – peripheral and central sensitization, descending modulation – there are several biopsychosocial factors involved in pain pathophysiology. Preventing the side effects of general anaesthesia, the ultrasound-guided peripheral nerve blockade is a safe technique with high success rate, rare side effects, achieving long-lasting, excellent analgesia. Continuous perineural catheter placed under ultrasound provides extended pain control. As a part of multimodal analgesia, peripheral nerve blockade prevents central sensitization. After surgery, the pain intensity of patients under peripheral nerve blockade is less, the chronification tendency is decreased, the quality of life and patients’ comfort are improved, and the stress-response is attenuated. The greater part of patients are protected from the undesirable side effects of general anaesthesia. Nowadays, it is an unequivocal evidence that the increasingly used peripheral nerve blockades prior to incision are efficient tools in the prevention of chronic postoperative pain. Ultrasound guidance is suitable not only for surgical anaesthesia, but for postoperative pain management as well, however, besides economic factors, the main goal of this technique is to match the best interest of the patients. Orv Hetil. 2019; 160(15): 573–584.

A New Paradigm for Neurological Lead Cyclic Testing

ASME 2006 Frontiers in Biomedical Devices Conference ◽

10.1115/nanobio2006-18023 ◽

2006 ◽

Author(s):

Paul Wisnewski

Keyword(s):

Chronic Pain ◽

Nervous System ◽

Electrical Stimulation ◽

Pain Management ◽

Standard Therapy ◽

Cyclic Testing ◽

New Paradigm ◽

Stimulation Of

The feasibility of electrical stimulation of the nervous system to treat chronic pain was proven with implantation of the first device for this purpose by Norm Shealy, MD in 1967. Since then, neurological stimulation has become a standard therapy for pain management.

Efficacy of pre-emptive use of cyclooxyenase-2 inhibitors for total knee arthroplasty: a mini-review

Arthroplasty ◽

10.1186/s42836-019-0015-3 ◽

2019 ◽

Vol 1 (1) ◽

Author(s):

Jianda Xu ◽

Huan Li ◽

Chong Zheng ◽

Bin Wang ◽

Pengfei Shen ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Pain Management ◽

Postoperative Pain ◽

Knee Arthroplasty ◽

Central Sensitization ◽

Postoperative Pain Management ◽

Functional Improvement ◽

Total Knee

AbstractTotal knee arthroplasty (TKA) is regarded as the most effective surgery for patients with later-stage arthritis of the knee, but the postoperative pain management for functional improvement of the knew is still a challenging task. This review discusses the mechanism by which the selective cyclooxyenase-2 inhibitors, which reduce the peripheral and central sensitization, decrease pain after TKA. This review also covers the protocols, safety, efficacy, and progress of cyclooxyenase-2 inhibitors in pre-emptive analgesia.

Preemptív és preventív analgesia – a perioperatív fájdalomcsillapítás fontos eleme

Orvosi Hetilap ◽

10.1556/650.2018.31045 ◽

2018 ◽

Vol 159 (17) ◽

pp. 655-660 ◽

Cited By ~ 2

Author(s):

Balázs Szedlák ◽

Calin Mitre ◽

Béla Fülesdi

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Postoperative Analgesia ◽

Tissue Damage ◽

Central Sensitization ◽

Postoperative Pain Management ◽

Surgical Incision ◽

High Importance ◽

History Of ◽

Tissue Trauma

Abstract: In this review, the definition and history of preemptive analgesia and the progress of its conception will be summarized. In the physiology-pathophysiology chapter, central sensitization, the key component of the evolution of postoperative pain, and the neurochemical processes in its background will be explored. Tissue damage caused by surgical incision consists of mechanical and inflammatory components, and it has high importance in the postoperative pain management. The preemptive approach of pain management means more than just preincisional analgesia, it includes the application of multifactious synergistic medication at the same time accordingly. All of these knowledges finally became complete in the conception of the perioperative approach of preventive pain management, which covers the premedication and mental support of a patient in the preoperative setting, furthermore consumes the whole armamentarium of the preemptive (preoperative), intraoperative and postoperative analgesia regimen as well. In practice, procedure-specific pain management should be highlighted, since it is based on the different extents and types of tissue trauma caused by various operations. Orv Hetil. 2018; 159(17): 655–660.

Ultrasound a New Paradigm in Regional Anesthesia and Pain Management

Anesthesiology and Pain Medicine ◽

10.5812/aapm.13363 ◽

2013 ◽

Vol 3 (2) ◽

pp. 228-229 ◽

Cited By ~ 3

Author(s):

Poupak Rahimzadeh ◽

Seyed Hamid Reza Faiz

Keyword(s):

Pain Management ◽

Regional Anesthesia ◽

New Paradigm

Solar Filaments as Tracers of Subsurface Processes

International Astronomical Union Colloquium ◽

10.1017/s0252921100064459 ◽

2000 ◽

Vol 179 ◽

pp. 177-183

Author(s):

D. M. Rust

Keyword(s):

Magnetic Fields ◽

Magnetic Flux ◽

Coronal Mass Ejections ◽

Interplanetary Space ◽

Intermediate Stage ◽

Coronal Plasma ◽

Magnetic Helicity ◽

The Sun ◽

New Paradigm ◽

Solar Filaments

AbstractSolar filaments are discussed in terms of two contrasting paradigms. The standard paradigm is that filaments are formed by condensation of coronal plasma into magnetic fields that are twisted or dimpled as a consequence of motions of the fields’ sources in the photosphere. According to a new paradigm, filaments form in rising, twisted flux ropes and are a necessary intermediate stage in the transfer to interplanetary space of dynamo-generated magnetic flux. It is argued that the accumulation of magnetic helicity in filaments and their coronal surroundings leads to filament eruptions and coronal mass ejections. These ejections relieve the Sun of the flux generated by the dynamo and make way for the flux of the next cycle.

The real cost of pain management

Anaesthesia ◽

10.1046/j.1365-2044.2001.02367.x ◽

2001 ◽

Vol 56 (11) ◽

pp. 1031-1033 ◽

Cited By ~ 8

Author(s):

C. J. Phillips

Keyword(s):

Pain Management ◽

The Real ◽

Real Cost

Procedural Coding for Interventional Pain Management

Techniques in Vascular and Interventional Radiology ◽

10.1016/j.tvir.2020.100703 ◽

2020 ◽

Vol 23 (4) ◽

pp. 100703

Author(s):

Shantanu Warhadpande ◽

Stephanie L. Dybul ◽

Minhaj S. Khaja

Keyword(s):

Pain Management ◽

Interventional Pain Management